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Zilbershlag Y. From Hospital to Home: Validating a Cognitive-Functional Evaluation of Elders (COFEE-HD). Can J Occup Ther 2024; 91:244-255. [PMID: 38783783 DOI: 10.1177/00084174241240226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Background. Increase in hospitalizations of older adults emphasizes the need for efficient hospital discharge planning to enable optimal reentry upon returning home. Yet few assessments offer an extensive picture of the older adult's functional-cognitive state. A comprehensive assessment for discharge planning together with a written summary can be beneficial to the older adult and family. Purpose. This quantitative study compared a modified version of a previously validated tool COFEE (cognitive OT functional evaluation of elders), for use in the hospital, HD (hospital discharge) with standard hospitals assessments. Methods. Of the 77 participants recruited in hospital, home assessments were conducted 4 months later on 64 participants. Findings. The COFEE-HD scores (physical functioning, personal and environmental safety and meta cognitive functioning) were significantly correlated with standard hospital measures and with the home assessment. Implications. The COFEE-HD was found to have a high level of validity in a hospital setting, and the resulting evaluation can provide important insights into function, safety and cognitive function for post-discharge behaviors.
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Wylie W, Coleman M, Geppert C, Arciniegas D, Whiton J, Quinn D. C-L Case Conference: Assessment of Dispositional Capacity in Medically Complex Patients. J Acad Consult Liaison Psychiatry 2024; 65:379-387. [PMID: 38548229 DOI: 10.1016/j.jaclp.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 08/30/2024]
Abstract
We present the case of a 76-year-old male with mild cognitive impairment and delirium who was referred to consultation-liaison psychiatry for an assessment of capacity to choose discharge. Cases involving "dispositional capacity" are complex and increasingly frequent, with momentous consequences for patients and their families, but are rarely discussed in the literature. In this article, experts in functional assessment, cognition, and ethics provide guidance for this commonly encountered clinical scenario based on their experience and available literature. We review the content and formulation of occupational and physical therapy assessments and their utility to the consultation-liaison psychiatrist. We also examine the relationship of cognitive impairment to decisional capacity and offer suggestions on a structured approach to evaluation. Finally, we discuss the ethical and systemic considerations of dispositional capacity and explore potential pitfalls that can lead to interprofessional conflict and missed opportunities in patient care.
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Affiliation(s)
- William Wylie
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - Mia Coleman
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Cynthia Geppert
- VA National Center for Ethics in Health Care, Raymond G Murphy Department of Veterans Affairs Medical Center, Albuquerque, NM
| | - David Arciniegas
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - James Whiton
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Davin Quinn
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM
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Henshaw AM, Winstead SR. Building Bridges in Palliative Rehabilitation: An Evidence-Based Toolkit to Promote Collaboration. Am J Hosp Palliat Care 2024; 41:601-609. [PMID: 37462170 DOI: 10.1177/10499091231184621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024] Open
Abstract
Background: Palliative care and rehabilitation professionals caring for seriously ill people and their families face barriers to effective, timely collaboration. Barriers such as ineffective communication processes, role misunderstanding across professions, and resource limitations can lead to underutilization of rehabilitation services for this vulnerable population. Objectives: To create practical connections between palliative care and rehabilitation professionals and to provide tools and strategies for teams to develop the core competencies (role clarity, communication, teamwork, and shared values) necessary to provide coordinated, timely, effective care to people living with serious illness. Design: With Interprofessional Education Collaborative (IPEC) Core Competencies1 as a framework for interprofessional collaborative practice, a quality improvement project was conducted at a large academic medical center. The 5-phase project included literature review, expert interviews, identification of barriers and facilitators, development of strategies to mitigate barriers, and pilot testing of select strategies. Results: The PalRehab Toolkit consists of strategies to enhance interprofessional collaborative practice and infuse rehabilitation into palliative care in the acute care setting. Preliminary evaluation of piloted strategies suggests increased communication across professions, improved role clarity, and an increased likelihood of collaboration. Conclusion: Providing educational offerings, establishing efficient communication channels, and infusing rehabilitation concepts into palliative care practices, as outlined in the PalRehab Toolkit, may positively impact interprofessional collaborative practice and improve care delivery for people with serious illness and their families.
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Affiliation(s)
- Ann M Henshaw
- Department of Occupational Therapy, Medstar Georgetown University Hospital, Washington, D.C. USA
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McNichols CC, Peterson AK, Reynolds S. The effect of occupational therapy services on hospital readmission for patients with cancer in acute care settings: a retrospective data analysis. J Cancer Surviv 2024:10.1007/s11764-024-01620-4. [PMID: 38819537 DOI: 10.1007/s11764-024-01620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE This study examined how the use of occupational therapy services affected the likelihood of hospital readmission within 30 days for patients with cancer diagnoses. METHODOLOGY This was a retrospective observational study. Patient medical records were analyzed from a National Cancer Institute Hospital over a 5-year period with a sample size of 6614 patients included for analysis in an unadjusted logistic regression model and 1920 patients analyzed in an adjusted logistic regression model. Various factors, including the use of occupational therapy services as well as individual factors such as pain levels, cancer stage, and living environment, were considered in relation to readmission status. Logistic regression analyses were used to assess the provision of occupational therapy service's association with 30-day hospital readmissions. RESULTS Patients who received occupational therapy services had a statistically significant decrease in their risk of a 30-day hospital readmission compared to patients with cancer who did not receive occupational therapy services. In an unadjusted analysis, patients with cancer who had occupational therapy services were 33.5% (OR = 0.665) less likely to be readmitted within 30 days compared to a patient who did not have occupational therapy services (p < 0.001). In an analysis after adjusting for patient health-related factors, patients with cancer who had occupational therapy services were 22.2% (OR = 0.778) less likely to readmit to a hospital compared to a patient who did not have occupational therapy services (p < 0.046). CONCLUSION The results of the study are intended to contribute to the body of knowledge on the benefits of occupational therapy services on an individual as well as a health systems-based level for patients with cancer diagnoses while hospitalized. IMPLICATIONS FOR CANCER SURVIVORS The knowledge of the utility of occupational therapy services for patients with cancer diagnoses while in the hospital can assist providers, patients, and hospital leadership in understanding some of the potential benefits for patient care and healthcare systems at large while seeking to avoid the deleterious effects from a hospital readmission.
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Affiliation(s)
- Christine C McNichols
- Occupational Therapy, Virginia Commonwealth University, 900 E. Leigh St, Richmond, VA, 23298, USA.
| | - Alicia K Peterson
- Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, USA
| | - Stacey Reynolds
- Occupational Therapy, Virginia Commonwealth University, 900 E. Leigh St, Richmond, VA, 23298, USA
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Kinney AR, Penzenik ME, Forster JE, O'Donnell F, Brenner LA. Association of Inpatient Occupational Therapy Utilization With Reduced Risk for Psychiatric Readmission Among Veterans. Psychiatr Serv 2024:appips20230650. [PMID: 38807577 DOI: 10.1176/appi.ps.20230650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE The authors sought to investigate whether utilization of inpatient occupational therapy (OT) was associated with reduced risk for 30-day psychiatric readmission in the Veterans Health Administration (VHA). METHODS The authors conducted a secondary analysis of VHA medical record data for veterans who received inpatient psychiatric care from 2015 to 2020 (N=176,889). Mixed-effects logistic regression was used to model psychiatric readmission within 30 days of discharge (yes or no) as a function of inpatient psychiatric OT utilization (none, one, two, three, or four or more encounters) and other care utilization (e.g., previous psychiatric hospitalization), as well as clinical (e.g., primary diagnosis), sociodemographic (e.g., race-ethnicity), and facility (e.g., complexity) characteristics. Sensitivity analyses were conducted to evaluate the robustness of findings (e.g., stratification by discharge disposition). RESULTS Relatively few veterans received inpatient psychiatric OT (26.2%), and 8.4% were readmitted within 30 days. Compared with veterans who did not receive inpatient psychiatric OT, those with one (OR=0.76), two (OR=0.64), three (OR=0.67), or four or more encounters (OR=0.64) were significantly (p<0.001) less likely to be readmitted within 30 days. These findings were consistent across all sensitivity analyses. CONCLUSIONS Veterans who received inpatient OT services were less likely to experience psychiatric readmission. A clear dose-response relationship between inpatient psychiatric OT and readmission risk was not identified. These findings suggest that OT services may facilitate high-value inpatient psychiatric care in the VHA by preventing readmissions that stymie recovery and incur high costs. Future research may establish the causality of this relationship, informing policy regarding increased access to inpatient psychiatric OT.
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Affiliation(s)
- Adam R Kinney
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado (Kinney, Penzenik, Forster, Brenner); Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora (Kinney, Penzenik, Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, D.C. (O'Donnell); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora (Brenner)
| | - Molly E Penzenik
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado (Kinney, Penzenik, Forster, Brenner); Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora (Kinney, Penzenik, Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, D.C. (O'Donnell); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora (Brenner)
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado (Kinney, Penzenik, Forster, Brenner); Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora (Kinney, Penzenik, Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, D.C. (O'Donnell); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora (Brenner)
| | - Frederica O'Donnell
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado (Kinney, Penzenik, Forster, Brenner); Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora (Kinney, Penzenik, Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, D.C. (O'Donnell); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora (Brenner)
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado (Kinney, Penzenik, Forster, Brenner); Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora (Kinney, Penzenik, Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, D.C. (O'Donnell); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora (Brenner)
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Sidar SS, Skuthan A. Occupational Therapy Practitioners' Perceptions of Providing Services for the Acute Postpartum Population. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241234846. [PMID: 38436257 DOI: 10.1177/15394492241234846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Occupational therapy practitioners' (OTP's) perceptions of their role in working on the acute postpartum hospital unit are unknown. The objective of this research was to determine the perspectives of OTP's enrolled in a continuing education course to gain competency in providing services to acute postpartum patients. Investigators engaged in a phenomenology consisting of semi-structured interviews with six OTP's working in acute care hospitals preparing to work on the postpartum unit. Three themes emerged from transcripts: (a) Its' Not THAT Different; (b) Willing To Try; and (c) Shifting Focus To Mom. OTPs working in hospitals identified existing skills applicable to working with acute postpartum patients, a need for additional learning to enhance competence, and a desire to focus support for the birthing person to improve maternal outcomes. Hospital onboarding and/or entry-level OTP programs should consider including education on the postpartum population. Future research should focus on program implementation on acute postpartum hospital units.
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Wasmuth S, Horsford C, Mahaffey L, Lysaker PH. "Metacognitive Reflection and Insight Therapy" (MERIT) for the Occupational Therapy Practitioner. Can J Occup Ther 2023; 90:333-343. [PMID: 36426583 DOI: 10.1177/00084174221142172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Background. Metacognitive Reflection and Insight Therapy (MERIT) is a manualized, evidence-based approach that supports occupational participation through its focus on the inter-related constructs of meaning making, positionality, and self-definition (Lysaker et al., 2020). MERIT's core tenets parallel the fundamentals of occupational therapy, making it an ideal guiding methodology for mental health occupational therapy practice. Purpose. We outline key constructs of MERIT and detail how occupational therapy practitioners can apply MERIT to support occupational engagement. Key Issues. Few manualized, evidence-based interventions exist to guide occupational therapy mental health practice (Kirsch et al., 2019). Detailing MERIT and its application in occupational therapy is an important first step in future studies of its feasibility, acceptability, and effectiveness in this context. Implications. MERIT provides a clear methodology for delivering mental health occupational therapy services that is amenable to large-scale hybrid implementation and effectiveness studies, thereby supporting practice and rigour in research.
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Low JK, Crawford K, Lai J, Manias E. Factors associated with readmission in chronic kidney disease: Systematic review and meta-analysis. J Ren Care 2023; 49:229-242. [PMID: 35809061 DOI: 10.1111/jorc.12437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/14/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Risk factors associated with all-cause hospital readmission are poorly characterised in patients with chronic kidney disease. OBJECTIVE A systematic review and meta-analysis were conducted to identify risk factors and protectors of hospital readmission in chronic kidney disease. DESIGN, PARTICIPANTS & MEASUREMENTS Studies involving adult patients were identified from four databases from inception to 31/03/2020. Random-effects meta-analyses were conducted to determine factors associated with all-cause 30-day hospital readmission in general chronic kidney disease, in dialysis and in kidney transplant recipient groups. RESULTS Eighty relevant studies (chronic kidney disease, n = 14 studies; dialysis, n = 34 studies; and transplant, n = 32 studies) were identified. Meta-analysis revealed that in both chronic kidney disease and transplant groups, increasing age in years and days spent at the hospital during the initial stay were associated with a higher risk of 30-day readmission. Other risk factors identified included increasing body mass index (kg/m2 ) in the transplant group, and functional impairment and discharge destination in the dialysis group. Within the chronic kidney disease group, having an outpatient follow-up appointment with a nephrologist within 14 days of discharge was protective against readmission but this was not protective if provided by a primary care provider or a cardiologist. CONCLUSION Risk-reduction interventions that can be implemented include a nephrologist appointment within 14 days of hospital discharge, rehabilitation programme for functional improvement in the dialysis group and meal plans in the transplant group. Future risk analysis should focus on modifiable factors to ensure that strategies can be tested and implemented in those who are more at risk.
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Affiliation(s)
- Jac Kee Low
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Kimberley Crawford
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Jerry Lai
- eSolution, Deakin University, Geelong, Victoria, Australia
- Intersect Australia, Sydney, New South Wales, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
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Rapolthy-Beck A, Fleming J, Turpin M, Sosnowski K, Dullaway S, White H. Efficacy of Early Enhanced Occupational Therapy in an Intensive Care Unit (EFFORT-ICU): A Single-Site Feasibility Trial. Am J Occup Ther 2023; 77:7706205110. [PMID: 38015492 DOI: 10.5014/ajot.2023.050230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE This research trial contributes to the evidence for occupational therapy service delivery in intensive care settings. OBJECTIVE To explore the feasibility of a trial to evaluate the impact of early enhanced occupational therapy on mechanically ventilated patients in intensive care. DESIGN Single-site assessor-blinded randomized controlled feasibility trial. SETTING Level 5 8-bed adult medical-surgical intensive care unit (ICU) at Logan Hospital, Brisbane, Australia. PARTICIPANTS Participants were 30 mechanically ventilated patients randomly allocated to two groups. OUTCOMES AND MEASURES We compared standard care with enhanced occupational therapy with outcomes measured at discharge from the ICU, hospital discharge, and 90 days post randomization. The primary outcome measure was the FIM®. Secondary outcomes included the Modified Barthel Index (MBI); Montreal Cognitive Assessment; grip strength, measured using a dynamometer; Hospital Anxiety and Depression Scale; and the 36-Item Short-Form Health Survey (Version 2). The intervention group received daily occupational therapy, including cognitive stimulation, upper limb retraining, and activities of daily living. Data were analyzed using independent groups t tests and effect sizes. RESULTS Measures and procedures were feasible. A significant difference was found between groups on FIM Motor score at 90 days with a large effect size (p = .05, d = 0.76), and MBI scores for the intervention group approached significance (p = .051) with a large effect size (d = 0.75) at 90 days. Further moderate to large effect sizes were obtained for the intervention group for cognitive status, functional ability, and quality of life. CONCLUSIONS AND RELEVANCE This trial demonstrated that occupational therapy is feasible and beneficial in the ICU. Criteria to progress to a full-scale randomized controlled trial were met. This study contributes to embedding ongoing consistency of practice and scope of service delivery for occupational therapy in this field. What This Article Adds: Occupational therapists should be considered core team members in the critical care-ICU, with funding to support ongoing service provision and optimization of patient outcomes based on effective and feasible service delivery.
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Affiliation(s)
- Andrea Rapolthy-Beck
- Andrea Rapolthy-Beck, MSc Neurorehabilitation, BScOccTher, BSc(Med)ExSc, is Senior Occupational Therapist, Occupational Therapy Department, Surgical Treatment and Rehabilitation Service, Herston Health Precinct, Queensland, Australia; Senior Occupational Therapist, Occupational Therapy Department, Logan Hospital, Meadowbrook, Queensland, Australia; and PhD Candidate, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia;
| | - Jennifer Fleming
- Jennifer Fleming, PhD, BOccThy (Hons), FOTARA, is Professor and Head, Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Merrill Turpin
- Merrill Turpin, PhD, BOccThy, GradDipCounsel, is Senior Lecturer, Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kellie Sosnowski
- Kellie Sosnowski, MNursing(Hons), BNursing, GradCertHlthMgt, GradDipCriticalCare, is Nurse Unit Manager, Intensive Care Unit, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Simone Dullaway
- Simone Dullaway, BAppSc (Occ Ther), is Senior Occupational Therapist, Chronic Disease Team, Metro South Health and Hospital Service, Queensland, Australia
| | - Hayden White
- Hayden White, PhD, MBBCH, FCP (SA), MMED (Wits), FCICM, FRACP, is Deputy Director, Intensive Care Unit, Logan Hospital, Meadowbrook, Queensland, Australia
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Johnson JK, Young DL, Guo N, Tereshchenko LG, Martinez M, Hohman JA, Rothberg MB. Physical therapy provision for patients with pneumonia in US hospitals. J Hosp Med 2023; 18:787-794. [PMID: 37602532 DOI: 10.1002/jhm.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Physical therapy (PT) appears beneficial for hospitalized patients. Little is known about PT practice patterns and costs across hospitals. OBJECTIVE To examine whether receiving PT is associated with specific patient and hospital characteristics for patients with pneumonia. We also explored the variability in PT service provision and costs between hospitals. METHODS We included administrative claims from 2010 to 2015 in the Premier Healthcare Database, inclusive of 644 US hospitals. We examined associations between receiving at least one PT visit and patient (age, race, insurance, intensive care utilization, comorbidity status, and length of stay) and hospital (academic status, rurality, size, and location) characteristics. Exploratory measures included timing and proportion of days with PT visits, and per-visit and per-admission costs. RESULTS Of 768,010 patients, 49% had PT. After adjustment, older age most significantly increased the probability of receiving PT (+38.0% if >80 vs. ≤50 years). Higher comorbidity burden, longer length of stay, and hospitalization in an urban setting were also associated with higher probability. Hospitalization in the South most significantly decreased the probability (-9.1% vs. Midwest). Patients without Medicare and Non-White patients also had lower probability. Median (interquartile range) days to first visit was 2 (1-4). Mean proportion of days with a visit was 35% ± 20%. Median per-visit cost was $88.90 [$56.70-$130.90] and per-admission was $224.00 [$137.80-$369.20]. CONCLUSION Both clinical (intensive care utilization and comorbidity status) and non-clinical (age, race, rurality, location) factors were associated with receiving PT. Within and between hospitals, there was high variability in the number and frequency of visits, and costs.
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Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel L Young
- Department of Physical Therapy, University of Nevada-Las Vegas, Las Vegas, Nevada, USA
| | - Ning Guo
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Maylyn Martinez
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jessica A Hohman
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio, USA
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Mofina A, Miller J, Tranmer J, Li W, Donnelly C. The association between receipt of home care rehabilitation services and acute care hospital utilization in clients with multimorbidity following an acute care unit discharge: a retrospective cohort study. BMC Health Serv Res 2023; 23:269. [PMID: 36934243 PMCID: PMC10024414 DOI: 10.1186/s12913-023-09116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/27/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Individuals experiencing multimorbidity have more complex healthcare needs, use more healthcare services, and access multiple service providers across the healthcare continuum. They also experience higher rates of functional decline. Rehabilitation therapists are well positioned to address these functional needs; however, little is known about the influence of rehabilitation therapy on patient outcomes, and subsequent unplanned healthcare utilization for people with multimorbidity. The aims of this study were to: 1) describe and compare the characteristics of people with multimorbidity receiving: home care rehabilitation therapy alone, other home care services without rehabilitation therapy, and the combination of home care rehabilitation therapy and other home care services, and 2) determine the association between home care rehabilitation therapy and subsequent healthcare utilization among those recently discharged from an acute care unit. METHODS This retrospective cohort study used linked health administrative data housed within ICES, Ontario, Canada. The cohort included long-stay home care clients experiencing multimorbidity who were discharged from acute care settings between 2007-2015 (N = 43,145). Descriptive statistics, ANOVA's, t-tests, and chi-square analyses were used to describe and compare cohort characteristics. Multivariable logistic regression was used to understand the association between receipt of rehabilitation therapy and healthcare utilization. RESULTS Of those with multimorbidity receiving long-stay home care services, 45.5% had five or more chronic conditions and 46.3% required some assistance with ADLs. Compared to people receiving other home care services, those receiving home care rehabilitation therapy only were less likely to be readmitted to the hospital (OR = 0.78; 95% CI: 0.73-0.83) and use emergency department services (OR = 0.73; 95% CI: 0.69-0.78) within the first 3-months following hospital discharge. CONCLUSIONS Receipt of rehabilitation therapy was associated with less unplanned healthcare service use when transitioning from hospital to home among persons with multimorbidity. These findings suggest rehabilitation therapy may help to reduce the healthcare burden for individuals and health systems. Future research should evaluate the potential cost savings and health outcomes associated with providing rehabilitation therapy services for people with multimorbidity.
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Affiliation(s)
- Amanda Mofina
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, ON, Canada
- ICES, Queen's, Kingston, ON, Canada
| | | | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Olivares-Tirado P, Zanga R. Waste in health care spending: A scoping review. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2023. [DOI: 10.1080/20479700.2023.2185580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Pedro Olivares-Tirado
- Research and Development Department of the Superintendency of Health of Chile, Santiago, Chile
- Adjunct researcher at Health Service Development Research Center, University of Tsukuba, Tsukuba, Japan
| | - Rosendo Zanga
- Research and Development Department of the Superintendency of Health of Chile, Santiago, Chile
- School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
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13
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Kumar A, Roy I, Falvey J, Rudolph JL, Rivera-Hernandez M, Shaibi S, Sood P, Childers C, Karmarkar A. Effect of Variation in Early Rehabilitation on Hospital Readmission After Hip Fracture. Phys Ther 2023; 103:pzac170. [PMID: 37172126 PMCID: PMC10071584 DOI: 10.1093/ptj/pzac170] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/18/2022] [Accepted: 10/16/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Provision of early rehabilitation services during acute hospitalization after a hip fracture is vital for improving patient outcomes. The purpose of this study was to examine the association between the amount of rehabilitation services received during the acute care stay and hospital readmission in older patients after a hip fracture. METHODS Medicare claims data (2016-2017) for older adults admitted to acute hospitals for a hip fracture (n = 131,127) were used. Hospital-based rehabilitation (physical therapy, occupational therapy, or both) was categorized into tertiles by minutes per day as low (median = 17.5), middle (median = 30.0), and high (median = 48.8). The study outcome was risk-adjusted 7-day and 30-day all-cause hospital readmission. RESULTS The median hospital stay was 5 days (interquartile range [IQR] = 4-6 days). The median rehabilitation minutes per day was 30 (IQR = 21-42.5 minutes), with 17 (IQR = 12.6-20.6 minutes) in the low tertile, 30 (IQR = 12.6-20.6 minutes) in the middle tertile, and 48.8 (IQR = 42.8-60.0 minutes) in the high tertile. Compared with high therapy minutes groups, those in the low and middle tertiles had higher odds of a 30-day readmission (low tertile: odds ratio [OR] = 1.11, 95% CI = 1.06-1.17; middle tertile: OR = 1.07, 95% CI = 1.02-1.12). In addition, patients who received low rehabilitation volume had higher odds of a 7-day readmission (OR = 1.20; 95% CI = 1.10-1.30) compared with high volume. CONCLUSION Elderly patients with hip fractures who received less rehabilitation were at higher risk of readmission within 7 and 30 days. IMPACT These findings confirm the need to update clinical guidelines in the provision of early rehabilitation services to improve patient outcomes during acute hospital stays for individuals with hip fracture. LAY SUMMARY There is significant individual- and hospital-level variation in the amount of hospital-based rehabilitation delivered to older adults during hip fracture hospitalization. Higher intensity of hospital-based rehabilitation care was associated with a lower risk of hospital readmission within 7 and 30 days.
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Affiliation(s)
- Amit Kumar
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Indrakshi Roy
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
- Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Jason Falvey
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science Baltimore, Maryland, USA
- University of Maryland School of Medicine, Department of Epidemiology and Public Health Baltimore, Maryland, USA
| | - James L Rudolph
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Maricruz Rivera-Hernandez
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Stefany Shaibi
- Creighton University Health Sciences Campus, Phoenix, Arizona, USA
| | - Pallavi Sood
- Center for Optimal Aging, Marymount University, Arlington, Virginia, USA
| | - Christine Childers
- Physical Therapy Program, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Amol Karmarkar
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Sheltering Arms Institute, Richmond, Virginia, USA
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14
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Chou A, Johnson JK, Jones DB, Euloth T, Matcho BA, Bilderback A, Freburger JK. Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study. Health Serv Res 2023; 58 Suppl 1:51-62. [PMID: 36271503 PMCID: PMC9843085 DOI: 10.1111/1475-6773.14087] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission. DATA SOURCES EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017-February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019-July 2021). STUDY DESIGN We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted. DATA EXTRACTION We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay. PRINCIPAL FINDINGS In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI -0.57, -0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (β = 0.01; 95% CI -0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI -0.88, -0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA. CONCLUSIONS Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.
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Affiliation(s)
- Aileen Chou
- Department of Physical TherapyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Joshua K. Johnson
- Department of Physical Medicine and RehabilitationNeurological Institute, Cleveland ClinicClevelandOhioUSA
| | - Daniel B. Jones
- Graduate School of Public and International AffairsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Tracey Euloth
- UPMC Rehabilitation ServicesPittsburghPennsylvaniaUSA
| | | | | | - Janet K. Freburger
- Department of Physical TherapyUniversity of PittsburghPittsburghPennsylvaniaUSA
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15
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Yamakawa S, Nagayama H, Tomori K, Ikeda K, Niimi A. Effectiveness of active occupational therapy in patients with acute stroke: A propensity score-weighted retrospective study. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:1045231. [PMID: 36684684 PMCID: PMC9849931 DOI: 10.3389/fresc.2022.1045231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
Background and purpose The effects of therapy and patient characteristics on rehabilitation outcomes in patients with acute stroke are unclear. We investigated the effects of intensive occupational therapy (OT) on patients with acute stroke. Methods We performed a retrospective cohort study using the 2005-2016 Japan Rehabilitation Database, from which we identified patients with stroke (n = 10,270) who were admitted to acute care hospitals (n = 37). We defined active OT (AOT) and non-AOT as OT intervention times (total intervention time/length of hospital stay) longer or shorter than the daily physical therapy intervention time, respectively. The outcomes assessed were the Functional Independence Measure (FIM) and National Institutes of Health Stroke Scale (NIHSS) scores, duration of hospitalization, and rate of discharge. Propensity scores and inverse probability of treatment weighting analyses adjusted for patient characteristics were performed to investigate the effects of AOT on patient outcomes. Results We enrolled 3,501 patients (1,938 and 1,563 patients in the AOT and non-AOT groups, respectively) in the study. After inverse probability of treatment weighting, the AOT group had a shorter length of hospitalization (95% confidence interval: -3.7, -1.3, p < 0.001), and the FIM (95% confidence interval: 2.0, 5.7, p < 0.001) and NIHSS (95% confidence interval; 0.3, 1.1, p < 0.001) scores improved significantly. Subgroup analysis showed that lower NHISS scores for aphasia, gaze, and neglect and lower overall NIHSS and FIM scores on admission led to a greater increase in FIM scores in the AOT group. Conclusions AOT improved the limitations in performing activities of daily living (ADL) and physical function in patients with acute stroke and reduced the length of hospitalization. Additionally, subgroup analysis suggested that the increase in FIM score was greater in patients with severe limitations in performing ADLs and worse cognitive impairment, such as neglect, on admission.
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Affiliation(s)
- Shiori Yamakawa
- Department of Occupational Therapy, Kinugasa Hospital, Yokosuka, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan,Correspondence: Hirofumi Nagayama
| | - Kounosuke Tomori
- Department of Occupational Therapy, Tokyo University of Technology, Tokyo, Japan
| | - Kohei Ikeda
- Department of Occupational Therapy, Kinugasa Hospital, Yokosuka, Japan
| | - Ayaka Niimi
- Department of Occupational Therapy, Yokohama Brain and Spine Center, Yokohama, Japan
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16
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Casey K, Sim E, Lavezza A, Iannuzzi K, Friedman LA, Hoyer EH, Young DL. Identifying Cognitive Impairment in the Acute Care Hospital Setting: Finding an Appropriate Screening Tool. Am J Occup Ther 2023; 77:24036. [PMID: 36764005 DOI: 10.5014/ajot.2023.050028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
IMPORTANCE Identifying cognitive impairment in adults in acute care is essential so that providers can address functional deficits and plan for safe discharge. Occupational therapy practitioners play an essential role in screening for, evaluating, and treating cognitive impairment. OBJECTIVE To test and compare the psychometrics and feasibility of three cognitive screens and select the ideal screen for use in acute care. DESIGN Prospective mixed methods. SETTING Acute care hospital. PARTICIPANTS Fifty adults. OUTCOMES AND MEASURES We examined the interrater reliability, administration time, and usability of the Brief Cognitive Assessment Tool Short Form (BCAT-SF), the Activity Measure for Post-Acute Care "6-Clicks" Applied Cognitive Inpatient Short Form (AM-PAC ACISF), and the Montreal Cognitive Assessment (MoCA). We compared the construct validity, sensitivity, and specificity of the BCAT-SF and AM-PAC ACISF with those of the MoCA. RESULTS Interrater reliability was good to excellent; ICCs were .98 for the MoCA, .97 for the BCAT-SF, and .86 for the AM-PAC ACISF. The BCAT-SF and the AM-PAC ACISF both had 100% sensitivity, and specificity was 74% for the BCAT-SF and 98% for the AM-PAC ACISF. The optimal cutoff score for cognitive impairment on the AM-PAC ACISF was <22. Administration time of the AM-PAC ACISF (1.0 min) was significantly less than that of the BCAT-SF (5.0 min) and the MoCA (13.3 min; p < .001). CONCLUSIONS AND RELEVANCE Each screen demonstrated acceptable reliability and construct validity. The AM-PAC ACISF had the optimum mix of performance and feasibility for the fast-paced acute care setting. What This Article Adds: Early identification of cognitive impairment using the AM-PAC ACISF can allow for timely occupational therapy intervention in acute care settings.
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Affiliation(s)
- Kelly Casey
- Kelly Casey, OTD, OTR/L, BCPR, ATP, CPAM, is Acute Care Therapy Services Team Leader, Johns Hopkins Hospital, Baltimore, MD;
| | - Erin Sim
- Erin Sim, OTD, OTR/L, PMP, is Acute Care Team Coordinator, Johns Hopkins Hospital, Baltimore, MD
| | - Annette Lavezza
- Annette Lavezza, OTR/L, is Director, Inpatient Therapy Services, Johns Hopkins Hospital, Baltimore, MD; Assistant Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD; and Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kristen Iannuzzi
- Kristen Iannuzzi, OTD, OTR/L, BCPR, CPAM, is Occupational Therapist and Occupational Therapy Acute Care Fellow, Johns Hopkins Hospital, Baltimore, MD
| | - Lisa Aronson Friedman
- Lisa Aronson Friedman, ScM, is Senior Biostatistician, Division of Pulmonary and Critical Care Medicine, and Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erik H Hoyer
- Erik H. Hoyer, MD, is Assistant Professor and Vice Chair for Quality and Safety, Department of Physical Medicine and Rehabilitation, and Member, Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Daniel L Young
- Daniel L. Young, PT, DPT, PhD, is Associate Professor, Department of Physical Therapy, University of Nevada; Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD; and Adjunct Associate Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
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17
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Lee PX, Wong TCS, Ng PYB, Yuen HCC, Pontre I, Craig J, Taylor S, Hatfield M. Coaching in an Acute Pediatric Setting: A Qualitative Approach to Understanding the Perspectives of Occupational Therapists. Phys Occup Ther Pediatr 2023; 43:212-227. [PMID: 36253934 DOI: 10.1080/01942638.2022.2131500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS To identify barriers and enablers to implementing coaching in acute pediatric settings from the perspective of occupational therapists and develop an implementation plan to address the identified barriers at a large metropolitan hospital. METHODS Participatory Action Research was used, and two stages of focus groups were conducted with 17 occupational therapists working in an acute pediatric hospital. Reflexive thematic analysis was employed for data analysis. RESULTS Stage one themes; (1) Lack of clarity around coaching definition, (2) Acute setting barriers to coaching, (3) Family acceptance and appropriateness, and (4) Enablers for coaching. Stage two themes; (1) Addressing skepticism about coaching, (2) Logistics and approvals, and (3) Implementation strategies for coaching. In Stage Two, participants and researchers developed an implementation plan. CONCLUSION Occupational therapists perceived coaching as hard to implement in acute pediatric settings due to acuity of caseloads and traditional medical models. The six-step implementation plan aims to enhance therapist knowledge and motivation as well as reduce environmental barriers, with the aim of embedding coaching into acute pediatric settings.
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Affiliation(s)
- Pei Xuan Lee
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | | | - Pei Yun Beatrice Ng
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | | | - Isabelle Pontre
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Joanna Craig
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Susan Taylor
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia.,Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Megan Hatfield
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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18
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García-Pérez P, Lara JP, Rodríguez-Martínez MDC, de la Cruz-Cosme C. Interventions within the Scope of Occupational Therapy in the Hospital Discharge Process Post-Stroke: A Systematic Review. Healthcare (Basel) 2022; 10:1645. [PMID: 36141257 PMCID: PMC9498873 DOI: 10.3390/healthcare10091645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Stroke is one of the main causes of disability in adulthood. Its rehabilitation is a complex process that requires a multidisciplinary team of specialised professionals. The main goal of this review was to determine the impact of occupational therapy intervention post-stroke on the home discharge process. A systematic search was carried out of the following databases: Pubmed, Web of Science, PsycINFO, Scopus, Otseeker, and Dialnet. A screening was performed taking into account the type of article, including exclusively RCT, and type of intervention, only including interventions within the scope of occupational therapy that take place during the process of hospital discharge post-stroke. A total of 2285 citations were identified in the search from which 13 articles met the inclusion criteria. Comparisons of the groups indicated that early occupational therapy intervention during the process of hospital discharge can be effective in terms of functional recovery and can lead to the caregiver seeing improvements in self-efficacy and fatigue. In addition, the inclusion of a caregiver in the intervention influences the patient's adherence to treatment, leading to a reduction in the cost of treatment and rehabilitation.
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Affiliation(s)
- Patricia García-Pérez
- Faculty of Medicine, University of Málaga, Blvr. Louis Pasteur, 32, 29010 Málaga, Spain
- Occupational Therapy Department, Virgen de la Victoria University Hospital, Servicio Andaluz de Salud (SAS), 29010 Málaga, Spain
| | - José Pablo Lara
- Faculty of Medicine, University of Málaga, Blvr. Louis Pasteur, 32, 29010 Málaga, Spain
- Brain Health Unit, CIMES, 29010 Málaga, Spain
- Malaga Biomedical Research Institute (IBIMA), 29010 Málaga, Spain
| | | | - Carlos de la Cruz-Cosme
- Malaga Biomedical Research Institute (IBIMA), 29010 Málaga, Spain
- Neurology Department, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
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19
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Holguin JA, Margetis JL, Narayan A, Yoneoka GM, Irimia A. Vascular Cognitive Impairment After Mild Stroke: Connectomic Insights, Neuroimaging, and Knowledge Translation. Front Neurosci 2022; 16:905979. [PMID: 35937885 PMCID: PMC9347227 DOI: 10.3389/fnins.2022.905979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Contemporary stroke assessment protocols have a limited ability to detect vascular cognitive impairment (VCI), especially among those with subtle deficits. This lesser-involved categorization, termed mild stroke (MiS), can manifest compromised processing speed that negatively impacts cognition. From a neurorehabilitation perspective, research spanning neuroimaging, neuroinformatics, and cognitive neuroscience supports that processing speed is a valuable proxy for complex neurocognitive operations, insofar as inefficient neural network computation significantly affects daily task performance. This impact is particularly evident when high cognitive loads compromise network efficiency by challenging task speed, complexity, and duration. Screening for VCI using processing speed metrics can be more sensitive and specific. Further, they can inform rehabilitation approaches that enhance patient recovery, clarify the construct of MiS, support clinician-researcher symbiosis, and further clarify the occupational therapy role in targeting functional cognition. To this end, we review relationships between insult-derived connectome alterations and VCI, and discuss novel clinical approaches for identifying disruptions of neural networks and white matter connectivity. Furthermore, we will frame knowledge translation efforts to leverage insights from cutting-edge structural and functional connectomics research. Lastly, we highlight how occupational therapists can provide expertise as knowledge brokers acting within their established scope of practice to drive substantive clinical innovation.
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Affiliation(s)
- Jess A. Holguin
- T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - John L. Margetis
- T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Anisha Narayan
- Tulane University School of Medicine, Tulane University, New Orleans, LA, United States
| | - Grant M. Yoneoka
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI, United States
| | - Andrei Irimia
- Leonard Davis School of Gerontology, Ethel Percy Andrus Gerontology Center, University of Southern California, Los Angeles, CA, United States
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
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20
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Marston C, Koye DN, Goonan R, Lim K, Juj G, Klaic M. Is there a relationship between intensity of occupational therapy and functional outcomes in hospitalised older patients? A prospective cohort study. Aust Occup Ther J 2022; 69:536-545. [PMID: 35502588 DOI: 10.1111/1440-1630.12808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Delivering high-intensity occupational therapy can improve functional outcomes for patients and reduce length of stay. However, there is little published evidence of this in the aged rehabilitation setting. This study aims to explore the association between intensity of occupational therapy interventions and functional outcomes in geriatric rehabilitation inpatients. METHODS A prospective cohort study was conducted with adult inpatients admitted to a geriatric rehabilitation program. The intervention was the intensity of occupational therapy measured as high (≥30 minutes per day) versus low (<30 minutes per day). The primary outcome measured was change in functional performance, defined as a minimum of half a point improvement in the Katz Index of Activities of Daily Living (ADL) and/or the Lawton and Brody Scale of Instrumental ADL (IADL) at admission to rehabilitation, discharge and 3months post-discharge. RESULTS A total of 693 patients were included in the analysis. The mean age was 82.2 years (standard deviation [SD] = 7.9), 57% were females, and 64% had cognitive impairment. Patients (n = 210) who received greater than or equal to 30 minutes of occupational therapy daily were more likely to have clinically relevant functional improvements.; for both ADL (odds ratio [OR] = 1.87, 95% confidence interval [CI]: 1.24-2.83) and IADL (OR = 3.00, 95% CI: 1.96-4.61), after adjusting for age, sex, severity of function (ADL ≤ 2) at admission, frailty and cognitive impairment. Improvements in ADL and IADL were maintained for at least 3 months following discharge. CONCLUSION This study found that geriatric rehabilitation inpatients who received higher intensity of occupational therapy interventions were more likely to functionally improve than those who received lower intensity. Further research is required to determine if other factors, such as therapy type, influence functional outcomes.
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Affiliation(s)
- Celia Marston
- Allied Health, Occupational Therapy Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Digsu N Koye
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,MISCH (Methods and Implementation Support for Clinical Health research platform), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rose Goonan
- Allied Health, Occupational Therapy Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kwang Lim
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Genevieve Juj
- Allied Health, Occupational Therapy Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Marlena Klaic
- Allied Health, Occupational Therapy Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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21
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Fisher AH, Gandhi J, Nelson Z, Pascuzzi C, Donley S, Franco MJ. Immediate Interventions After Surgery to Reduce Readmission for Upper Extremity Infections. Ann Plast Surg 2022; 88:S163-S169. [PMID: 35513315 DOI: 10.1097/sap.0000000000003141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Upper extremity infections (UEIs), commonly caused by intravenous drug use and direct trauma to the hand, can be devastating. Many studies support hand therapy postoperatively to improve outcomes. This population of patients often experience increased returns to the emergency department (ED) for treatment, repeat surgery, poor function, and increased hospital expenditure.This is a 2-phase study to investigate and intervene on the care pathway for patients undergoing surgery for UEI at a single urban university hospital. For the first 6-month phase, all patients with UEI requiring surgery received the standard of care, including written discharge instructions, a scheduled follow-up, and a determination for hand therapy based on evaluation. During the second phase, over the following 6 months, all patients with UEI requiring surgery received an intervention before discharge, in addition to standard of care, including a scripted educational session on the importance of hand therapy by a resident physician, home exercise program instructions, and a referral to hand therapy before discharge. Outcome measures were assessed for 6 months. Outcome measures included follow-up, hand therapy attendance, ED visits for the same complaint, readmissions, and reoperations.Forty-seven patients were in the first control group without intervention and 41 patients were in the second intervention group. Of the control group, 43% attended a follow-up appointment, 2% attended hand therapy, and 45% presented to the ED, resulting in a total of 167 visits. Eleven presented to the ED and were readmitted for complications from surgery, all 11 required a second operation. In the intervention group, 54% attended a follow-up appointment (P = 0.044), more patients attended hand therapy (22% P = 0.013), and 24% presented to the ED (P = 0.047), resulting in 40 ED visits.Seven were readmitted for complications from surgery and 4 required a second operation (P = 0.1). Early, simple intervention and education prove to be an effective method to decrease emergency department burden and healthcare expenditure for treatment of a challenging population. Although additional education and referral to hand therapy utilization do not change operation rates, it decreased returns to the ED, readmissions, and increased follow-up.
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Affiliation(s)
| | - Jigar Gandhi
- Orthopedic Surgery, Cooper University Health Care
| | | | | | - Sarah Donley
- Cooper Occupational and Hand Therapy, Camden, NJ
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22
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Rapolthy-Beck A, Fleming J, Turpin M. Occupational therapy service provision in adult intensive care units in Australia: A survey of workload practices, interventions and barriers. Aust Occup Ther J 2022; 69:316-330. [PMID: 35224739 PMCID: PMC9306833 DOI: 10.1111/1440-1630.12794] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Occupational therapy practice within intensive care units (ICUs) is limited with respect to published research evidence and guidelines regarding scope of practice. An understanding of the current level of service provision, feasibility of services in ICUs and training and development needs of occupational therapists is required to enable consistent best practice and promote the occupational therapy profile. This study aimed to explore occupational therapy practice within ICUs in Australia including the barriers and enablers to practice perceived by occupational therapists. METHODS In this cross-sectional study, a national customised online survey was completed by registered occupational therapists who provide services in intensive care settings in Australia. Recruitment was from July to September 2019 through Occupational Therapy Australia and other professional networks and interest groups. RESULTS The survey was completed by 43 respondents. The majority were experienced therapists from Queensland with greater than 10-years post-qualification and working in a tertiary hospital setting. The most common length of time spent working in the ICU was 0-2 h per week. Formal and informal self-care measures, cognitive screens and physical outcome measures were commonly used. Bed-based grooming retraining, pressure care management, functional upper limb retraining and passive ranging were the most frequent interventions provided on a daily basis. Perceived barriers to occupational therapy service provision in ICU included lack of funding for staffing, competing workload demands, lack of occupational therapy role delineation and scope of practice and lack of published evidence and training. CONCLUSION Occupational therapy services in intensive care settings in Australia are limited. Published practice guidelines, further research, applications for service funding and ongoing education of the ICU multidisciplinary team regarding the scope of occupational therapy practice are recommended to promote the development of occupational therapy services in ICU.
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Affiliation(s)
- Andrea Rapolthy-Beck
- Occupational Therapy Department, Surgical Treatment and Rehabilitation Service, Herston Health Precinct, Herston, Australia.,Logan Hospital, Meadowbrook, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Merrill Turpin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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23
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Lucas Molitor W, Feldhacker DR, Lohman H, Lampe AM, Jensen L. Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions. Am J Occup Ther 2022; 76:23116. [PMID: 34962516 DOI: 10.5014/ajot.121.049044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. OBJECTIVE In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. DATA SOURCES We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.
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Affiliation(s)
- Whitney Lucas Molitor
- Whitney Lucas Molitor, PhD, OTD, OTR/L, BCG, is Assistant Professor, Department of Occupational Therapy, and Undergraduate Public Health Program Director, University of South Dakota, Vermillion;
| | - Diana R Feldhacker
- Diana R. Feldhacker, OTD, OTR/L, BCPR, is Department Chair, Program Director, and Assistant Professor, Department of Occupational Therapy, Des Moines University, Des Moines, IA
| | - Helene Lohman
- Helene Lohman, OTD, OTR/L, is Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Angela M Lampe
- Angela M. Lampe, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Lou Jensen
- Lou Jensen, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
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Lucas Molitor W, Feldhacker DR, Lohman H, Lampe AM, Jensen L. Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions. Am J Occup Ther 2022; 76:23123. [PMID: 34967846 DOI: 10.5014/ajot.2022.049044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. OBJECTIVE In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. DATA SOURCES We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.
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Affiliation(s)
- Whitney Lucas Molitor
- Whitney Lucas Molitor, PhD, OTD, OTR/L, BCG, is Assistant Professor, Department of Occupational Therapy, and Undergraduate Public Health Program Director, University of South Dakota, Vermillion;
| | - Diana R Feldhacker
- Diana R. Feldhacker, OTD, OTR/L, BCPR, is Department Chair, Program Director, and Assistant Professor, Department of Occupational Therapy, Des Moines University, Des Moines, IA
| | - Helene Lohman
- Helene Lohman, OTD, OTR/L, is Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Angela M Lampe
- Angela M. Lampe, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Lou Jensen
- Lou Jensen, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
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Kinney AR, Graham JE, Bukhari R, Hoffman A, Malcolm MP. Activities of Daily Living Performance and Acute Care Occupational Therapy Utilization: Moderating Factors. Am J Occup Ther 2022; 76:23141. [PMID: 34997754 DOI: 10.5014/ajot.2022.049060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. OBJECTIVE To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. DESIGN A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. PARTICIPANTS A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. INTERVENTION None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care "6-Clicks" measure of daily activity. RESULTS Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. CONCLUSIONS AND RELEVANCE Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - James E Graham
- James E. Graham, PhD, DC, FACRM, is Professor, Department of Occupational Therapy, and Director, Center for Community Partnerships, Colorado State University, Fort Collins
| | - Rayyan Bukhari
- Rayyan Bukhari, MSOT, is PhD Student, Department of Occupational Therapy, Colorado State University, Fort Collins, and Lecturer, Department of Occupational Therapy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amanda Hoffman
- Amanda Hoffman, MSOT, OTR/L, BCPR, is Inpatient Rehabilitation Supervisor, UCHealth, University of Colorado Hospital, Anschutz Medical Campus, Aurora
| | - Matt P Malcolm
- Matt P. Malcolm, PhD, OTR/L, is Associate Professor and PhD Program Director, Department of Occupational Therapy, Colorado State University, Fort Collins, and Colorado School of Public Health, Colorado State University, Fort Collins
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Edelstein J, Walker R, Middleton A, Reistetter T, Gary KW, Reynolds S. Higher Frequency of Acute Occupational Therapy Services Is Associated With Reduced Hospital Readmissions. Am J Occup Ther 2022; 76:23119. [PMID: 34964838 DOI: 10.5014/ajot.2022.048678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Hospital readmissions are associated with poor patient outcomes, including higher risk for mortality, nutritional concerns, deconditioning, and higher costs. OBJECTIVE To evaluate how acute occupational therapy service delivery factors affect readmission risk. DESIGN Cross-sectional, retrospective study. SETTING Single academic medical center. PARTICIPANTS Medicare inpatients with a diagnosis included in the Hospital Readmissions Reduction Program (HRRP; N = 17,618). Data were collected from medical records at a large urban hospital in southeastern Wisconsin. Outcomes and Measures: Logistic regression models were estimated to examine the association between acute occupational therapy service delivery factors and odds of readmission. In addition, the types of acute occupational therapy services for readmitted versus not-readmitted patients were compared. RESULTS Patients had significantly higher odds of readmission if they received occupational therapy services while hospitalized (odds ratio [OR] = 1.18, 95% confidence interval [CI] [1.07, 1.31]). However, patshients who received acute occupational therapy services had significantly lower odds of readmission if they received a higher frequency (OR = 0.99, 95% CI [0.99,1.00]) of acute occupational therapy services. A significantly higher proportion of patients who were not readmitted, compared with patients who were readmitted, received activities of daily living (ADL) or self-care training (p < .01). CONCLUSIONS AND RELEVANCE For patients with HRRP-qualifying diagnoses who received acute occupational therapy services, higher frequency of acute occupational therapy services was linked with lower odds of readmission. Readmitted patients were less likely to have received ADL or self-care training while hospitalized. What This Article Adds: Identifying factors of acute occupational therapy services that reduce the odds of readmission for Medicare patients may help to improve patient outcomes and further define occupational therapy's role in the U.S. quality-focused health care system.
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Affiliation(s)
- Jessica Edelstein
- Jessica Edelstein, PhD, OTR/L, is Occupational Therapy Postdoctoral Fellow, Department of Occupational Therapy, Colorado State University, Fort Collins. At the time of the study, Edelstein was Occupational Therapist, Department of Rehabilitation, Froedtert Hospital, Milwaukee, WI, and PhD Student, Virginia Commonwealth University, Richmond, VA;
| | - Rebekah Walker
- Rebekah Walker, PhD, is Associate Professor, Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, and Associate Director, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Addie Middleton
- Addie Middleton, PhD, DPT, is Clinician Scientist, New England Geriatric Research and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA
| | - Timothy Reistetter
- Timothy Reistetter, PhD, OTR, FAOTA, is Associate Dean of Research and Professor, School of Health Professions, Department of Occupational Therapy, University of Texas Health Science Center at San Antonio
| | - Kelli Williams Gary
- Kelli Williams Gary, PhD, MPH, OTR/L, is Associate Professor, Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond
| | - Stacey Reynolds
- Stacey Reynolds, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond
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Lockwood KJ, Porter J. Effectiveness of Hospital-Based Interventions by Occupational Therapy Practitioners on Reducing Readmissions: A Systematic Review With Meta-Analyses. Am J Occup Ther 2022; 76:7601180050. [PMID: 35044450 DOI: 10.5014/ajot.2022.048959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Readmission to the hospital can lead to poorer patient outcomes and increased health care costs. The effect of occupational therapy interventions for adult hospitalized patients on readmission rates has not been previously evaluated. OBJECTIVE To systematically examine the published literature to determine the effects of occupational therapy interventions for adult hospitalized patients on readmission rates. DATA SOURCES Systematic search of five electronic databases was performed from database inception until May 2020, supplemented by citation and reference list searches. Study Selection and Data Collection: This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively; methodological quality of the included studies was assessed using the Downs and Black checklist. Meta-analyses were conducted with clinically homogeneous data; the overall body of evidence was graded for quality. FINDINGS Meta-analysis of 7 studies with 16,718 participants provided low-quality evidence that 1-mo readmission rates were reduced when adult patients hospitalized for general medical and surgical care received additional occupational therapy interventions compared with standard care. Subgroup analysis of 4 studies provided moderate-quality evidence that interventions focusing on the transition from hospital to the community were effective in reducing 1-mo readmissions to hospitals compared with standard care. CONCLUSIONS AND RELEVANCE Occupational therapy interventions can be effective in reducing readmissions among some adult hospitalized patient populations, including those admitted for surgery or management of acute medical conditions, with stronger evidence to support transitional care interventions. What This Article Adds: Occupational therapy interventions can be effective in reducing readmissions among adult hospitalized patients. There is a continued need for occupational therapy practitioners to understand their value and contribution to reducing avoidable readmissions to hospitals.
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Affiliation(s)
- Kylee J Lockwood
- Kylee J. Lockwood, PhD, is Lecturer, Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Judi Porter
- Judi Porter, PhD, is Professor in Dietetics, School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia;
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Edelstein J, Middleton A, Walker R, Reistetter T, Reynolds S. Impact of Acute Self-Care Indicators and Social Factors on Medicare Inpatient Readmission Risk. Am J Occup Ther 2022; 76:23120. [PMID: 34964839 DOI: 10.5014/ajot.2022.049084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Readmissions are costly for Medicare and are associated with poor patient outcomes. OBJECTIVE To determine whether two domains relevant to acute occupational therapy practice-self-care status and social factors-were associated with readmissions for Medicare patients in the Medicare Hospital Readmissions Reduction Program (HRRP). DESIGN Cross-sectional, retrospective study. SETTING Single academic medical center. PARTICIPANTS Medicare inpatients with a diagnosis included in the HRRP (N = 17,618). Outcomes and Measures: Three logistic regression models were estimated to examine the associations among (1) self-care status and 30-day readmission, (2) social support and 30-day readmission, and (3) housing situation and 30-day readmission. Subgroup analyses were conducted for the individual HRRP diagnoses. RESULTS No associations were found between acute self-care status, social support, or housing situation and 30-day readmission when all HRRP diagnoses were examined together. However, higher levels of independence with self-care were significantly associated with reduced odds of readmission for patients with pneumonia. CONCLUSIONS AND RELEVANCE The findings for patients with pneumonia are consistent with those of other studies done in the acute care setting. Deficiencies in acute occupational therapy documentation may have affected the findings for the other HRRP diagnoses. What This Article Adds: This study is the first to examine the association between acute self-care status (as documented by acute care occupational therapy practitioners) and readmission.
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Affiliation(s)
- Jessica Edelstein
- Jessica Edelstein, PhD, OTR/L, is Occupational Therapy Postdoctoral Fellow, Department of Occupational Therapy, Colorado State University, Fort Collins. At the time of the study, Edelstein was Occupational Therapist, Department of Rehabilitation, Froedtert Hospital, Milwaukee, WI, and PhD Student, Virginia Commonwealth University, Richmond;
| | - Addie Middleton
- Addie Middleton, PhD, DPT, is Clinician Scientist, New England Geriatric Research and Clinical Center, U.S Department of Veterans Affairs Boston Healthcare System, Boston, MA
| | - Rebekah Walker
- Rebekah Walker, PhD, is Associate Professor, Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, and Associate Director, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Timothy Reistetter
- Timothy Reistetter, PhD, OTR, FAOTA, is Associate Dean of Research and Professor, School of Health Professions, Department of Occupational Therapy, University of Texas Health Science Center at San Antonio
| | - Stacey Reynolds
- Stacey Reynolds, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond
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Shaw A, Cabrejo PT, Adamczyk A, Mulcahey MJ. Reducing Hospital Readmissions of Older Adults Pursuing Postacute Care at Skilled Nursing Facilities: A Scoping Review. Am J Occup Ther 2022; 76:23144. [PMID: 34997839 DOI: 10.5014/ajot.2022.049082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Unplanned hospital readmissions can profoundly affect older adults' quality of life and the financial status of skilled nursing facilities (SNFs). Although many clinical practices focus on reforming these issues, occupational therapy's involvement remains unclear. OBJECTIVE To explore clinical practices aimed at reducing hospital readmissions of older adults pursuing postacute care (PAC) at SNFs and describe how they align with occupational therapy's scope of practice. DATA SOURCES We searched CINAHL, Scopus, PubMed, and OTseeker for articles published from January 2011 to February 2020. Study Selection and Data Collection: We conducted a scoping review of peer-reviewed articles with functional outcomes of clinical practices reducing unplanned hospital readmissions of patients older than age 65 yr pursuing PAC services in SNFs. Trained reviewers completed the title and abstract screens, full-text reviews, and data extraction. FINDINGS Thirteen articles were included and focused on five areas: risk and medical disease management and follow-up, hospital-to-SNF transition, enhanced communication and care, function, and nutrition. Early coordination of care and early identification of patients' needs and risk of readmission were common features. All clinical practices aligned with occupational therapy domains and processes, but only 1 study specified occupational therapy as part of the research team. CONCLUSIONS AND RELEVANCE Comprehensive, multipronged clinical practices encompassing care coordination and early identification and management of acute conditions are critical in reducing preventable readmissions among older adults pursuing PAC services in SNFs. Further research is needed to support occupational therapy's value in preventing hospital readmissions of older adults in this setting. What This Article Adds: This scoping review maps the presence of occupational therapy's domains and processes in the clinical practices that reduce hospital readmissions of older adults pursuing PAC services in SNFs. Findings provide occupational therapy practitioners with opportunities to assume roles beyond direct patient care, research, advocate, and publish more, thereby increasing their presence and adding value to occupational therapy interventions that reduce hospital readmissions.
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Affiliation(s)
- Antoinette Shaw
- Antoinette Shaw, OTD, OTR/L, is Director of Rehabilitation Services, Genesis Healthcare Corporation, Catonsville, MD;
| | - Pamela Talero Cabrejo
- Pamela Talero Cabrejo, OTD, OTR/L, is Adjunct Assistant Professor, Post-Professional Occupational Therapy Program, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Abby Adamczyk
- Abby Adamczyk, MLIS, AHIP, is Professional Librarian, Thomas Jefferson University, Philadelphia, PA
| | - M J Mulcahey
- MJ Mulcahey, PhD, OTR/L, is Professor of Occupational Therapy, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
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Kinney AR, Graham JE, Bukhari R, Hoffman A, Malcolm MP. Activities of Daily Living Performance and Acute Care Occupational Therapy Utilization: Moderating Factors. Am J Occup Ther 2022; 76:23139. [PMID: 34990509 DOI: 10.5014/ajot.121.049060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. OBJECTIVE To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. DESIGN A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. PARTICIPANTS A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. INTERVENTION None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care "6-Clicks" measure of daily activity. RESULTS Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. CONCLUSIONS AND RELEVANCE Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - James E Graham
- James E. Graham, PhD, DC, FACRM, is Professor, Department of Occupational Therapy, and Director, Center for Community Partnerships, Colorado State University, Fort Collins
| | - Rayyan Bukhari
- Rayyan Bukhari, MSOT, is PhD Student, Department of Occupational Therapy, Colorado State University, Fort Collins, and Lecturer, Department of Occupational Therapy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amanda Hoffman
- Amanda Hoffman, MSOT, OTR/L, BCPR, is Inpatient Rehabilitation Supervisor, UCHealth, University of Colorado Hospital, Anschutz Medical Campus, Aurora
| | - Matt P Malcolm
- Matt P. Malcolm, PhD, OTR/L, is Associate Professor and PhD Program Director, Department of Occupational Therapy, Colorado State University, Fort Collins, and Colorado School of Public Health, Colorado State University, Fort Collins
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Malcolm MP, Kinney AR, Graham JE. Predicting Community Discharge for Occupational Therapy Recipients in the Neurological Critical Care Unit. Am J Occup Ther 2022; 76:23111. [PMID: 34935915 DOI: 10.5014/ajot.2022.045450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy in the neurological critical care unit (NCCU) may enable safe community discharge by restoring functional ability. However, the influence of patient characteristics and NCCU occupational therapy on discharge disposition is largely unknown. OBJECTIVE To examine how patient factors and receipt of occupational therapy predict discharge disposition for NCCU patients. DESIGN Retrospective cross-sectional cohort study of electronic health records data from adults admitted to the NCCU between May 2013 and September 30, 2015. SETTING NCCU in a large urban academic hospital. PARTICIPANTS Adults age 18 yr or older (N = 1,134) admitted to the NCCU. Outcomes and Measures: Using logistic regression with discharge disposition as the dependent variable, we entered sex, age, length of stay (LOS), baseline Glasgow Coma Scale score, Elixhauser Comorbidity Index, and receipt of occupational therapy services as predictor variables. RESULTS Of NCCU patients, 39% received occupational therapy. Younger age, shorter LOS, lower comorbidity burden, and not receiving occupational therapy services increased the likelihood of discharge to the community. Men who received occupational therapy were less likely to be discharged to the community than men who did not receive occupational therapy. As age increased, differences in the probability of community discharge decreased between recipients and nonrecipients of occupational therapy services. CONCLUSIONS AND RELEVANCE Our results suggest that patients receiving occupational therapy services in the NCCU may have a lower likelihood of community discharge. However, these findings may result from therapist's consideration of the safest discharge location to ensure the greatest balance between independence and support. What This Article Adds: This study's findings suggest that receipt of occupational therapy in the NCCU is associated with higher likelihood for noncommunity discharge (i.e., to inpatient rehabilitation, skilled nursing, or long-term care). However, activity limitations and comorbidity burden may be greater for recipients of occupational therapy, and these NCCU patients are presumably less prepared for community discharge.
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Affiliation(s)
- Matt P Malcolm
- Matt P. Malcolm, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Colorado State University, Fort Collins, and Associate Professor, Colorado School of Public Health, Aurora;
| | - Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora
| | - James E Graham
- James E. Graham, PhD, DC, FACRM, is Professor, Department of Occupational Therapy, Colorado State University, Fort Collins
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Whitman MV, Matthews RA, Williams ES. Examining supervisor undermining through the job-demands resources framework. Health Serv Manage Res 2021; 35:206-214. [PMID: 34882019 DOI: 10.1177/09514848211048608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Supervisor undermining has recently gained increasing attention due to its negative effects on employee health and well-being. In the healthcare context, negative supervisor behaviors have been linked to unfavorable individual and organizational outcomes as well as medical errors and patient mortality. Our study, therefore, examines the influence that supervisor undermining behavior has on employee engagement and performance within a standard job stress framework. METHODS Our sample consisted of occupational therapists, a health professions group who is growing in demand and importance in the U.S. and has unique job demands. Using an observational, cross-sectional study design, a convenience sample of 521 occupational therapists completed an online survey. A series of independent t-test and multiple-groups path analytic modeling was used. RESULTS Participants who had a supervisor perceived as engaging in undermining behaviors reported lower levels of resources, higher levels of demands, less motivation, and more overload than those who did not perceive supervisor undermining. These participants were also less engaged and reported lower levels of performance. CONCLUSION Our results shed further light on the importance of supervisory behaviors specifically in a healthcare setting and the need for organizations to create an environment that promotes positive and productive workplace behaviors.
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García-Pérez P, Rodríguez-Martínez MDC, Lara JP, de la Cruz-Cosme C. Early Occupational Therapy Intervention in the Hospital Discharge after Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412877. [PMID: 34948486 PMCID: PMC8700854 DOI: 10.3390/ijerph182412877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
Stroke is the leading cause of acquired disability in adults which is a cerebrovascular disease of great impact in health and social terms, not only due to its prevalence and incidence but also because of its significant consequences in terms of patient dependence and its consequent impact on the patient and family lives. The general objective of this study is to determine whether an early occupational therapy intervention at hospital discharge after suffering a stroke has a positive effect on the functional independence of the patient three months after discharge—the patient’s level of independence being the main focus of this research. Data will be collected on readmissions to hospitals, mortality, returns to work and returns to driving, as well as an economic health analysis. This is a prospective, randomized, controlled clinical trial. The sample size will be made up of 60 patients who suffered a stroke and were discharged from the neurology unit of a second-level hospital in west Malaga (Spain), who were then referred to the rehabilitation service by the joint decision of the neurology and rehabilitation department. The patients and caregivers assigned to the experimental group were included in an early occupational therapy intervention program and compared with a control group that receives usual care.
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Affiliation(s)
- Patricia García-Pérez
- Faculty of Medicine, University of Málaga, 29010 Málaga, Spain;
- Occupational Therapy Department, Hospital Marítimo, Servicio Andaluz de Salud (SAS), 29620 Málaga, Spain
| | | | - José Pablo Lara
- Faculty of Medicine, University of Málaga, 29010 Málaga, Spain;
- Brain Health Unit, CIMES, 29010 Málaga, Spain
- Malaga Biomedical Research Institute (IBIMA), 29010 Málaga, Spain;
- Correspondence: (M.C.R.-M.); (J.P.L.)
| | - Carlos de la Cruz-Cosme
- Malaga Biomedical Research Institute (IBIMA), 29010 Málaga, Spain;
- Neurology Department, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
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Alothman L, Bélanger AM, Ruel I, Brunham LR, Hales L, Genest J, Akioyamen LE. Health-related quality of life in homozygous familial hypercholesterolemia: A systematic review and meta-analysis. J Clin Lipidol 2021; 16:52-65. [PMID: 35027327 DOI: 10.1016/j.jacl.2021.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/04/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Homozygous familial hypercholesterolemia (HoFH) is a rare genetic disease characterized by extreme elevations of low-density lipoprotein cholesterol (LDL-C) and extremely premature atherosclerotic cardiovascular disease. To date, impacts of HoFH and its treatment on the psychosocial wellbeing of patients have been poorly characterized. OBJECTIVES We performed a systematic review of the association between HoFH and health-related quality of life (HRQL). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) consensus guidelines. We searched MEDLINE, Embase, The Cochrane Controlled Register of Trials (CENTRAL), Pubmed, Scopus, AfricaWide (via EBSCO), and six trial registries and grey-literature databases from inception to May 2021 for published English-language literature examining HRQL and its determinants in HoFH. Studies were eligible if they included patients with confirmed HoFH and evaluated HRQL using validated tools. We performed a narrative synthesis of qualitative findings from included studies and, where data permitted, random-effects meta-analysis reporting standardized mean differences (SMD) and 95% confidence intervals (CIs). RESULTS Our review identified seven eligible studies examining HRQL in HoFH participants. Pooling data from two included studies, we found that relative to the general population, HoFH patients demonstrated significantly poorer HRQL in multiple dimensions of the 36-item Short-Form Health Survey (SF-36) with lower scores in physical functioning (SMD -0.37; 95% CI: -0.60, -0.15), role limitations due to physical health (SMD -0.63; 95% CI: -1.24, -0.02), social functioning (SMD -0.61; 95% CI: -1.19, -0.03), bodily pain (SMD -0.24; 95% CI: -0.46, -0.01), and general health (SMD -1.55; 95% CI: -1.80, -1.31). No differences were observed in domains of energy and vitality, mental health and emotional well-being, or role limitations due to emotional problems. Patients suffered high treatment burdens related to lipoprotein apheresis that compromised educational attainment and employment. However, few patients received psychological support in navigating their treatment challenges. No studies evaluated the association of HoFH with incident anxiety, depression, or other psychopathology. CONCLUSIONS Limited data are available on quality of life for patients with HoFH. The available data suggest that these patients may suffer disease-related impairments in quality of life. Future work should aim to elucidate relationships between HoFH and mental health outcomes and develop interventions to improve quality of life in this population.
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Affiliation(s)
- Latifah Alothman
- Research Institute of the McGill University Health Centre, Montreal QC H4A 3J1, Canada
| | - Alexandre M Bélanger
- Research Institute of the McGill University Health Centre, Montreal QC H4A 3J1, Canada
| | - Isabelle Ruel
- Research Institute of the McGill University Health Centre, Montreal QC H4A 3J1, Canada
| | - Liam R Brunham
- Department of Medicine, University of British Columbia, Vancouver, V5Z 1M9, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, V6Z 1Y6, Canada
| | - Lindsay Hales
- McGill University Health Center Medical Libraries, Montreal QC, H3G 1A4, Canada
| | - Jacques Genest
- Research Institute of the McGill University Health Centre, Montreal QC H4A 3J1, Canada
| | - Leo E Akioyamen
- Department of Medicine, University of Toronto, Toronto ON, M5S 1A8, Canada.
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Wasmuth S, Wilburn VG, Hamm JA, Chase A. Comparing narrative-informed occupational therapy in adult outpatient mental health to treatment as usual: A quasi-experimental feasibility study with preliminary treatment outcomes. OCCUPATIONAL THERAPY IN MENTAL HEALTH 2021; 37:56-71. [PMID: 34744219 DOI: 10.1080/0164212x.2020.1845276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper describes implementation of a narrative-informed occupation-based service in an outpatient community mental health setting that addressed several gaps, including 1) the need for outcome data on occupational therapy in this setting; 2) an ongoing mental health provider shortage; and 3) a need for innovative approaches to supporting mental health. We found a significant improvement from baseline to post-intervention in occupational participation, and dose of occupational therapy was significantly related to improvements in the areas of roles, habits, values, long-term goals, social environment, and readiness for change. This study suggests future, larger effectiveness studies of narrative-informed occupation-based interventions delivered by occupational therapists in outpatient community mental health are warranted.
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Affiliation(s)
- Sally Wasmuth
- Indiana University School of Health and Human Sciences, Department of Occupational Therapy, 1140 W. Michigan Street, Indianapolis, IN 46202
| | - Victoria G Wilburn
- Indiana University School of Health and Human Sciences, Department of Occupational Therapy, 1140 W. Michigan Street, Indianapolis, IN 46202
| | - Jay A Hamm
- Sandra Eskenazi Mental Health Center, Eskenazi Health, Indianapolis, IN 46202, United States College of Pharmacy, Purdue University, West Lafayette, IN 47907
| | - Anthony Chase
- Indiana University School of Health and Human Sciences, Department of Occupational Therapy, 1140 W. Michigan Street, Indianapolis, IN 46202
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Capo-Lugo CE, Askew RL, Boebel M, DeLeo C, Deutsch A, Heinemann A. A comparative approach to quantifying provision of acute therapy services. Medicine (Baltimore) 2021; 100:e27377. [PMID: 34622841 PMCID: PMC8500582 DOI: 10.1097/md.0000000000027377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/13/2021] [Indexed: 01/05/2023] Open
Abstract
This study aims to compare delivery of acute rehabilitation therapy using metrics reflecting distinct aspects of rehabilitation therapy services. Seven general medical-surgical hospitals in Illinois and Indiana prospectively collected rehabilitation therapy data. De-identified data on all patients who received any type of acute rehabilitation therapy (n = 35,449) were extracted and reported as aggregate of minutes of therapy services per discipline. Metrics included therapy types, total minutes, and minutes per day (intensity), as charted by therapists. Extended hospital stay was defined as a length of stay (LOS) longer than Medicare's geometric mean LOS. Discharge destination was coded as postacute care or home discharge. Substantial variability was observed in types, number of minutes, and intensity of therapy services by condition and hospital. The odds of an extended hospital stay increased with increased number of minutes, increased number of therapy types, and decreased with increased rehabilitation intensity. This comparative approach to assessing provision of acute therapy services reflect differential effects of service provision on LOS and discharge destination. Investigators, policymakers, and hospital administrators should examine multiple metrics of rehabilitation therapy provision when evaluating the impact of health care processes on patient outcomes.
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Affiliation(s)
- Carmen E. Capo-Lugo
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, AL
| | | | | | | | - Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
- RTI International, Chicago, IL
| | - Allen Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
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George S, Barrett M, De Ionno J, Fletcher L, Choo WS, Rivas-Dominguez S, Romanic N, Lizarondo L, Stern C. Experiences and effectiveness of occupational therapy interventions delivered in the acute setting: a mixed methods systematic review protocol. JBI Evid Synth 2021; 19:2457-2463. [PMID: 34100827 DOI: 10.11124/jbies-20-00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review is to synthesize and integrate the best available evidence on the experiences and effectiveness of occupational therapy interventions delivered in the acute setting. INTRODUCTION Occupational therapy is a client-centered health profession promoting health and well-being through occupation. In acute hospital settings, occupational therapy interventions are provided to patients to maximize function, prevent readmission, and promote safe discharge. Recent studies have demonstrated that occupational therapy has modified its practice in acute settings to include advocacy, team facilitation, and rapid clinical reasoning. This review will investigate not only the effectiveness of occupational therapy interventions, but also the experiences of patients, caregivers, and clinicians in the acute setting. INCLUSION CRITERIA This review will consider qualitative, quantitative, and mixed methods studies on the experiences and effectiveness of occupational therapy interventions delivered in acute settings. For the qualitative component, the experiences of patients and caregivers receiving any occupational therapy intervention, and clinicians directly or indirectly involved in delivering occupational therapy interventions, will be investigated. For the quantitative component, occupational therapy interventions will be compared with non-occupational therapy interventions, no intervention, wait-list, or other inactive or active (usual care) control interventions. Patient outcomes will include impairment, activities of daily living, psychological outcomes, and quality of life, while health system outcomes will include health care utilization and patient flow. METHODS The databases to be searched include CINAHL, Cochrane Controlled Trials Register, MEDLINE (Ovid), OT Seeker, PsycINFO (Ovid), and Scopus. Study selection, critical appraisal, data extraction, and data synthesis and integration will utilize the JBI segregated approach to mixed methods systematic reviews. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020206363.
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Affiliation(s)
- Stacey George
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia.,Occupational Therapy, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Matt Barrett
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jessica De Ionno
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Laura Fletcher
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Wen Shin Choo
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Sergio Rivas-Dominguez
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Nikolina Romanic
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Lucylynn Lizarondo
- JBI, Faculty of Health and Medical Science, The University of Adelaide, Adelaide, SA, Australia
| | - Cindy Stern
- JBI, Faculty of Health and Medical Science, The University of Adelaide, Adelaide, SA, Australia
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Prusynski RA, Frogner BK, Skillman SM, Dahal A, Mroz TM. Therapy Assistant Staffing and Patient Quality Outcomes in Skilled Nursing Facilities. J Appl Gerontol 2021; 41:352-362. [PMID: 34291695 DOI: 10.1177/07334648211033417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Therapy staffing declined in response to Medicare payment policy that removes incentives for intensive physical and occupational therapy in skilled nursing facilities, with therapy assistant staffing more impacted than therapist staffing. However, it is unknown whether therapy assistant staffing is associated with patient outcomes. Using 2017 national data, we examined associations between therapy assistant staffing and three outcomes: patient functional improvement, community discharge, and hospital readmissions, controlling for therapy intensity and facility characteristics. Assistant staffing was not associated with functional improvement. Compared with employing no assistants, staffing 25% to 75% occupational therapy assistants and 25% to 50% physical therapist assistants were associated with more community discharges. Higher occupational therapy assistant staffing was associated with higher readmissions. Higher intensity physical therapy was associated with better quality across outcomes. Skilled nursing facilities seeking to maximize profit while maintaining quality may be successful by choosing to employ more physical therapy assistants rather than sacrificing physical therapy intensity.
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Abstract
Despite technological advancements in health care documentation and the proliferation of electronic health records, health information and health data remain disparate. Patients and health care teams benefit from access to comprehensive patient records to make informed health care decisions. Significant governmental policy and investments have been made to promote interoperability of systems that connect health information with the ultimate intent of developing a longitudinal patient record. In this article, we discuss how health data, interoperability, and related systems are influenced by federal policy. The intent is to expand occupational therapy practitioners' understanding of the promise of interoperability and the role the occupational therapy profession can play in advancing the infrastructure needed to optimize health care delivery.
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Affiliation(s)
- Joy Doll
- Joy Doll, OTD, OTR/L, FNAP, is Vice President, Community and Academic Programs, CyncHealth, Omaha, NE
| | - Julie Malloy
- Julie Malloy, MOT, OTR/L, PMP, CPHQ, is Director of Quality, Practice Improvement, American Occupational Therapy Association, North Bethesda, MD;
| | - Jaime Bland
- Jaime Bland, DNP, MBA, RN, is President and Chief Executive Officer, CyncHealth, Nebraska Health Information Initiative, Omaha
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Dreyer G, van Niekerk M. Vocational rehabilitation for young stroke survivors in Gauteng public healthcare: Occupational therapists' perceptions1. Work 2021; 69:91-107. [PMID: 33998574 DOI: 10.3233/wor-213460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The prevalence of working-aged stroke survivors is increasing yearly. Stroke is an expensive disease, causing financial burden to the government, the family and caregivers of the patient, thus making it imperative for working-aged stroke survivors to work to remain financially independent. Survivors' need to work necessitates occupational therapists to shift their focus from basic activities of daily living, to rehabilitating work. OBJECTIVES This study aimed to determine the perceptions of occupational therapists working with younger stroke survivors in public hospitals and clinics in Gauteng South Africa, about rehabilitating working-aged stroke survivors' work ability. METHODS Ethical clearance was obtained. A qualitative research design was used to obtain narrative, descriptive data from six focus groups. Therapists from public healthcare settings, who had more than six months' experience and had worked in neurological rehabilitation within the six months preceding the focus group, were invited to participate. Focus groups were audio recorded and transcribed. Inductive content analysis was used to identify themes and categories. RESULTS Few participants are involved in rehabilitating younger stroke survivors' work ability or facilitating return to work (RTW). The study identified perceived barriers and enablers to rendering OT services that meet working-aged stroke survivors' needs. CONCLUSIONS Despite enabling employment equity laws in South Africa, OTs working in the public sector appear to experience a sense of futility when trying to rehabilitate young stoke survivors to RTW. Fragmentation of the public sector and limited resources impede successful RTW for working-aged stroke survivors. Survivors' employment status and motivation to RTW facilitated rehabilitating work ability.
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Affiliation(s)
- Greea Dreyer
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matty van Niekerk
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Justice H, Haines D, Wright J. Occupational therapy for adults with intellectual disabilities and sensory processing challenges: a Delphi study exploring practice within acute assessment and treatment units. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2021. [DOI: 10.1108/ijot-11-2020-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Lack of research means guidance regarding the most effective sensory interventions for adults with intellectual disabilities is limited. Preliminary consensus evidence was created by gathering experienced occupational therapists’ views on practice. The purpose of this study was to establish important elements of practice when using sensory integration-informed approaches on assessment and treatment units.
Design/methodology/approach
A modified Delphi process was used to gather, explore and synthesise the views of 13 occupational therapists. Data was collected via online surveys and included quantitative importance ratings and qualitative comments.
Findings
An experienced panel was in strong agreement regarding many elements of practice they felt were important for use in this setting, and a list of important practice items was created. Two themes were identified: “Complexity” and “Pragmatism vs. Ideal World.” The themes highlight challenges to practice in this area and the complex clinical reasoning used to overcome these.
Research limitations/implications
Participants disagreed about the level of importance of a substantial number of items, therefore items that did not reach consensus may still be important.
Practical implications
This study indicates potentially helpful clinical tools, facilities and training and identifies support needed for occupational therapists working in these settings.
Originality/value
This study contributes to the body of knowledge regarding how occupational therapists do and could work with people with intellectual disabilities and sensory integration difficulties. Although this study takes a UK and Ireland perspective, similar agendas regarding care and support for those with intellectual disabilities internationally mean findings are relevant more widely.
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Bathje M, Conrad S, Medick M, Ross M, Fogg L. Differences in Hospital-Based Care for Patients With Intellectual and Developmental Disabilities. Am J Occup Ther 2021; 75:12499. [PMID: 34781343 DOI: 10.5014/ajot.2021.046508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The number of adults with intellectual and developmental disabilities (IDD) seeking treatment in non-IDD-specific health care settings is growing. Little is known about how adults with IDD use health care services in specialty settings, including occupational therapy services. OBJECTIVE To describe adults with IDD in hospitals and identify differences in utilization patterns compared with patients without IDD. DESIGN Descriptive and correlational designs were used. PARTICIPANTS Data were obtained from Vizient (Clinical Data Base/Resource Manager™), a national database of administrative discharge abstracts for adults admitted to hospitals for an orthopedic procedure. From this sample, subsamples of (1) patients diagnosed with IDD and (2) an age- and gender-matched sample of patients without IDD were identified. RESULTS The study cohort with IDD experienced longer lengths of stay, t(2821.5) = -14.2, p < .001; were more likely to have Medicare coverage, χ2(3, N = 8,472) = 1,170.38, p < .001; and were more commonly discharged to subacute or skilled nursing facilities, χ2(5, N = 8,472) = 1,033.60, p < .001. Differences in occupational therapy services were also noted. CONCLUSIONS AND RELEVANCE Despite similarities in orthopedic procedures, participants with IDD had different use patterns than those without IDD. Differences may be attributed to varying client factors and contexts. The results also indicate that practitioners in non-IDD-specific settings should expect to encounter clients with IDD. Occupational therapy practitioners have an opportunity to be leaders in adapting treatment protocols and providing education to caregivers and health care providers on behalf of people with IDD. What This Article Adds: This article provides novel information about a population that is known to experience disparities in health outcomes. It offers a basis on which future research can build to improve health care delivery and occupational therapy interventions to improve outcomes.
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Affiliation(s)
- Molly Bathje
- Molly Bathje, PhD, MS-HSM, OTR/L, is Assistant Professor, Department of Occupational Therapy, Rush University, Chicago, IL;
| | - Samantha Conrad
- Samantha Conrad, BS, is OTD Student, Department of Occupational Therapy, Rush University, Chicago, IL
| | - Matthew Medick
- Matthew Medick, BS, is OTD Student, Department of Occupational Therapy, Rush University, Chicago, IL
| | - Molly Ross
- Molly Ross, BS, is OTD Student, Department of Occupational Therapy, Rush University, Chicago, IL
| | - Lou Fogg
- Lou Fogg, PhD, is Professor, Department of Community, Systems and Mental Health Nursing, Rush University, Chicago, IL
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Margetis JL, Wilcox J, Thompson C, Mannion N. Occupational Therapy: Essential to Critical Care Rehabilitation. Am J Occup Ther 2021; 75:7502170010p1-7502170010p5. [PMID: 33657342 DOI: 10.5014/ajot.2021.048827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic reshaped the health care landscape, leading to the reassignment of essential health care workers to critical areas and widespread furloughs of providers deemed nonessential, including occupational therapy practitioners. Although multidisciplinary critical care teams often include occupational therapy practitioners, efforts to define, measure, and disseminate occupational therapy's unique contributions to critical care outcomes have been overlooked. This editorial provides recommendations to improve the occupational therapy profession's readiness to meet society's current and future pandemic needs. We propose a three-pronged strategy to strengthen occupational therapy clinical practice, education, and advocacy to illuminate the distinct value of occupational therapy in critical care.
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Affiliation(s)
- John L Margetis
- John Margetis, OTD, OTR/L, is Associate Professor of Clinical Occupational Therapy, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles
| | - Jamie Wilcox
- Jamie Wilcox, OTD, OTR/L, is Assistant Professor of Clinical Occupational Therapy, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles;
| | - Chelsea Thompson
- Chelsea Thompson, MOT, OTR/L, BCPR, is Occupational Therapist, University of Chicago Medical Center, Chicago, IL
| | - Nicole Mannion
- Nicole Mannion, MA, OTR/L, is Occupational Therapist, Kindred Rehabilitation
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Skaltsi P, Konstantinou G, Papagathangelou M, Angelopoulos E, Papageorgiou CC. The Role of Occupational Therapy Within an Acute Mental Health Setting: A Naturalistic Cohort Study. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210207-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Educator’s Guide for Addressing Cultural Awareness, Humility, and Dexterity in Occupational Therapy Curricula. Am J Occup Ther 2020. [DOI: 10.5014/ajot.2020.74s3005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Occupational therapists are ethically bound to provide quality care to assist all people across the life course to engage in meaningful occupations. This sense of purpose, however, is challenged by institutional, systemic, and attitudinal barriers to equitable care for racial and ethnic minorities and other marginalized identities. Future practitioners must learn how to provide culturally appropriate care characterized by awareness, humility, and dexterity in client interactions. This guide offers information, strategies, and resources for enhancing learner knowledge, skills, and attitudes through intentional and effective curriculum design practices. It is intended to assist educators with integrating cultural awareness, humility, and dexterity into intended learning outcomes; course topics; formal, informal, and hidden curricula; teaching approaches; and instructional strategies.
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Rich T, Hicks B, Dahl A, Sullivan E, Barrett B, Bedore B. Preliminary experiences in acute occupational therapy for in-patients with coronavirus-19 (COVID-19): leveraging assistive technology in three case studies of male veterans. Disabil Rehabil Assist Technol 2020; 17:283-289. [PMID: 33356663 DOI: 10.1080/17483107.2020.1852326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Coronavirus 2019 (COVID-19) was first identified in December 2019 with millions of cases reported globally in the succeeding months. Initial hospitalisation strives to minimise multisystem organ failure and of those that survive, individuals can present with profound rehabilitation needs. The purpose of this case series is to describe occupational therapy (OT) and special technology considerations for three male Veteran patients hospitalised with suspected or confirmed COVID-19. Methods: This is a descriptive case series using a retrospective electronic health record review at a Veterans Administration hospital. The case series includes three male Veterans with confirmed or suspected COVID-19 (ages 69-78) who were referred to OT. The cases were selected to demonstrate the novel use of technology and strategies to reduce the risk of transmission. In two of three of our cases, we describe acute rehabilitation with a focus on activity tolerance, participation in occupations, and discharge planning. In all cases, we measured vital signs and activity tolerance as primary outcomes. Results and conclusions: The findings suggest that outcome measures focussing on activity tolerance to maintain stable vital signs during the recovery phase is central to the progression of activities. We observed in our cases that the Person-Environment-Occupation-Performance (PEOP) model can guide practice and complement the medical model in management of these patients. We utilised technology to engage family members in the rehabilitation care and minimise exposure risks.IMPLICATIONS FOR REHABILITATIONAcute occupational therapy for rehabilitation early in the recovery of Cornavirus-2019 can be guided by the Person-Occupation-Environment-Performance model as seen in this case series of three Veteran patients.Assistive technology can serve dual roles in supporting the rehabilitation of individuals with Cornavirus-2019 and lowering the risk of virus transmission to staff.
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Affiliation(s)
- Tonya Rich
- Veterans Administration Health Care System, One Veterans Drive, Minneapolis, MN, USA.,Department of Rehabilitation Medicine, Rehabilitation Science Graduate Program, University of Minnesota, Minneapolis, MN, USA
| | - Brandon Hicks
- Veterans Administration Health Care System, One Veterans Drive, Minneapolis, MN, USA
| | - Abigail Dahl
- Veterans Administration Health Care System, One Veterans Drive, Minneapolis, MN, USA
| | - Elle Sullivan
- Veterans Administration Health Care System, One Veterans Drive, Minneapolis, MN, USA
| | - Benjamin Barrett
- Veterans Administration Health Care System, One Veterans Drive, Minneapolis, MN, USA
| | - Beau Bedore
- Veterans Administration Health Care System, One Veterans Drive, Minneapolis, MN, USA
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Occupational Therapy’s Commitment to Diversity, Equity, and Inclusion. Am J Occup Ther 2020; 74:7413410030p1-7413410030p6. [DOI: 10.5014/ajot.2020.74s3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
The American Occupational Therapy Association’s (AOTA’s) Vision 2025 conveys a strong commitment to diversity, equity, and inclusion (AOTA, 2019). AOTA affirms the inalienable right of every individual to feel welcomed, valued, a sense of belonging, and respected while accessing and participating in society, regardless of the internal or external factors that make every individual unique. This statement supports efforts to increase diversity, equity, and inclusion within all aspects of occupational therapy, including practice, education, and research, as well as policy development and advocacy.
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Barclay L, Lalor A, Furmston B, Fossey E, Farnworth L, Smith A, Bourke-Taylor H. Occupational therapy and allied health use for older people in acute care: A description of services, time, and readmission in an Australian setting. Br J Occup Ther 2020. [DOI: 10.1177/0308022620956574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Acute care readmissions of older people are an ongoing concern in many countries. Occupational therapists are well positioned to play a significant role in contributing to improved outcomes and fewer readmissions following discharge from acute hospitals, yet there is a lack of empirical evidence to support this claim. Methods This study used a retrospective clinical audit of secondary hospital data to investigate and describe the time spent on occupational therapy, and the range of occupational therapy and other allied health services provided to older people admitted to acute care, in one Australian health care service. Results Occupational therapists conducted numerous assessments and interventions to support patients and to prepare them for safe discharge home. Occupational therapy was significantly associated with length of stay. Readmission was not related directly or significantly to time spent in occupational therapy or any other factor included in this study. However, of the people who received occupational therapy, there was a higher percentage readmitted when they had more services already in place on admission and when they lived alone. Conclusions This study provides preliminary evidence regarding the contact time and range of occupational therapy assessments and interventions provided to older people in the acute hospital setting.
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Affiliation(s)
- Linda Barclay
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Aislinn Lalor
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Bianca Furmston
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Louise Farnworth
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | | | - Helen Bourke-Taylor
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
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Schiltz NK, Dolansky MA, Warner DF, Stange KC, Gravenstein S, Koroukian SM. Impact of Instrumental Activities of Daily Living Limitations on Hospital Readmission: an Observational Study Using Machine Learning. J Gen Intern Med 2020; 35:2865-2872. [PMID: 32728960 PMCID: PMC7573020 DOI: 10.1007/s11606-020-05982-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limitations in instrumental activities of daily living (IADL) hinder a person's ability to live independently in the community and self-manage their conditions, but its impact on hospital readmission has not been firmly established. OBJECTIVE To test the importance of IADL dependency as a predictor of 30-day readmissions and quantify its impact relative to other morbidities. DESIGN A retrospective cohort study of the population-based Health and Retirement Study linked to Medicare claims data. Random forest was used to rank each predictor variable in terms of its ability to predict readmission. Classification and regression tree (CART) was used to identify complex multimorbidity combinations associated with high or low risk of readmission. Generalized linear regression was used to estimate the adjusted relative risk of readmission for IADL limitations. SUBJECTS Hospitalizations of adults age 65 and older (n = 20,007), from 6617 unique subjects. MAIN MEASURES The main outcome was 30-day all-cause unplanned readmission. The main predictor of interest was self-reported IADL limitation. Other key predictors were self-reported complex multimorbidity including chronic diseases, geriatric syndromes, and activities of daily living (ADL) limitations, along with demographic, socioeconomic, and behavioral factors. KEY RESULTS The overall 30-day readmission rate in the study was 16.4%. Random forest analysis ranked ADLs and IADL limitations as the two most important predictors of 30-day readmission. CART identified hospitalizations of patients with IADL limitations and diabetes as a subgroup at the highest risk of readmission (26% readmitted). Multivariable regression analyses showed that ADL limitations were associated with 1.17 (1.06-1.29) times higher risk of readmission even after adjusting for other patient covariates. Risk prediction was modest though for even the best model (AUC = 0.612). CONCLUSIONS IADL limitations are key predictors of 30-day readmission as demonstrated using several machine learning methods. Routine assessment of functional abilities in hospital settings could help identify those most at risk.
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Affiliation(s)
- Nicholas K Schiltz
- Frances Payne Bolton School of Nursing , Case Western Reserve University, 10900 Euclid Avenue, Room 459H, Cleveland, OH, 44106-7343, USA. .,Department of Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing , Case Western Reserve University, 10900 Euclid Avenue, Room 459H, Cleveland, OH, 44106-7343, USA.,Department of Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David F Warner
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kurt C Stange
- Department of Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Family & Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University, Providence, RI, USA.,Alpert School of Medicine, Brown University, Providence, RI, USA.,Center for Gerontology and Healthcare Research, Brown University, Providence, RI, USA.,Providence Veterans Administration Medical Center, Providence, RI, USA
| | - Siran M Koroukian
- Department of Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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Roberts P, Robinson M, Furniss J, Metzler C. Occupational Therapy's Value in Provision of Quality Care to Prevent Readmissions. Am J Occup Ther 2020; 74:7403090010p1-7403090010p9. [PMID: 32365306 DOI: 10.5014/ajot.2020.743002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Health care systems are prioritizing the quality of outcomes over the quantity of services provided, and health care payers and other stakeholders are focusing on preventing hospital readmissions. This priority supports the effort to reduce the cost of health care by avoiding the most expensive care type and improving the quality of health care by promoting sustained return to the community and remaining in the community. Occupational therapy practitioners have expertise that is critically important in this effort. Occupational therapy places a unique and immediate focus on patients' functional and social needs, which can be important drivers of readmissions if they are not addressed. By addressing activities of daily living, instrumental activities of daily living, functional cognition, psychosocial needs, vision, fear of falling, and safety, occupational therapy practitioners can be a valuable addition to the effort to keep people out of the hospital and participating in their lives. This article reviews the literature supporting the role of occupational therapy in each of these key areas.
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Affiliation(s)
- Pamela Roberts
- Pamela Roberts, PhD, OTR/L, SCFES, FAOTA, CPHQ, FNAP, FACRM, is Executive Director and Professor, Department of Physical Medicine and Rehabilitation and Executive Director to the Chief Medical Officer, Cedars-Sinai Medical Center, Los Angeles;
| | - Marla Robinson
- Marla Robinson, MSc, OTR/L, BCPR, BT-C, FAOTA, is Assistant Director, Inpatient Therapy Services, University of Chicago Medicine, Chicago
| | - Jeremy Furniss
- Jeremy Furniss, OTD, OTR/L, BCG, is Vice President, Knowledge and Data Science, Division of Finance and Administration, American Occupational Therapy Association, North Bethesda, MD
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